Oral delivery of peptide pharmaceutical compositions

ABSTRACT

Bioavailability of peptide active agents to be administered orally is enhanced by a pharmaceutical composition providing targeted release of the peptide to the intestine by combining the composition with an absorption enhancer. Bioavailability is further significantly increased by administering the composition in an acid-resistant protective vehicle which transports components of the invention through the stomach. The composition may optionally further include a sufficient amount of a pH-lowering agent to lower local intestinal pH. All components are released together into the intestine with the peptide.

CROSS REFERENCE TO A RELATED APPLICATION

The present application is a 35 U.S.C. §119 conversion of ProvisionalApplication Ser. No. 60/580,872 filed Jun. 18, 2004

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to oral peptide pharmaceuticalcompositions having analgesic and/or cardiovascular activity, and tomethods of enhancing bioavailability of such peptides when administeredorally.

2. Description of the Related Art

Opiates such as morphine and codeine, or opiate-like synthetic drugs arecurrently used for the management of moderate to severe pain. Manyendogenous peptides of mammalian and amphibian origin (e.g., theendorphins) also bind to opioid receptors and elicit an analgesicresponse similar to classic narcotic opiates. This led to the hope thatthese peptides might be produced commercially and administered topatients to, e.g., relieve pain. It was found, however, that sideeffects such as depression of cardiac and respiratory function,tolerance, physical dependence capacity and precipitated withdrawalsyndrome are caused by nonspecific interactions between such peptidesand central nervous system receptors. Such side effects are due to theinteraction of these peptides with multiple opioid receptors. For thisreason, peptides with a variety of structural modifications have beendeveloped in an effort to develop peptide-based pharmaceuticals that arespecific for a particular opioid receptor sub-type [mu, delta andkappa], and which produce long-lasting antinociceptive effects whileminimizing undesirable side effects such as depression of cardiac and/orrespiratory function, extended sedative activity, etc.

Peptide pharmaceuticals known in the prior art, including the analgesicpeptides described above, frequently have been administered by injectionor by nasal administration. A more preferred oral administration tendsto be problematic because peptide-active compounds are very susceptibleto degradation in the stomach and intestines and show poorbioavailability. For example, the prior art is not believed to havereported to achieve reproducible blood levels of opioid peptides whenadministered orally. This is believed to be because peptides lacksufficient stability in the gastrointestinal tract, and tend to bepoorly transported through intestinal walls into the blood. However,injection and nasal administration are significantly less convenient,and involve more patient discomfort, than oral administration. Oftenthis inconvenience or discomfort results in substantial patientnoncompliance with a treatment regimen. Thus there is a need in the artfor a more effective and reproducible oral administration of peptidepharmaceuticals including, but not limited to, peptide pharmaceuticalshaving analgesic and/or cardiovascular activity.

Proteolytic enzymes of both the stomach and intestines may degradepeptides, rendering them inactive before they can be absorbed into thebloodstream. Any amount of peptide that survives proteolytic degradationby proteases of the stomach (typically having acidic pH optima) is laterconfronted with proteases of the small intestine and enzymes secreted bythe pancreas (typically having neutral to basic pH optima). Specificdifficulties arising from the oral administration of a peptide involvethe relatively large size of the molecule, and the charge distributionit carries. This may make it more difficult for such peptides topenetrate the mucus along intestinal walls or to cross the intestinalbrush border membrane into the blood. These additional problems mayfurther contribute to limited bioavailability.

SUMMARY OF THE INVENTION

Recent advances in the field of analgesic peptides have been directedtowards the derivatization of these peptides to protect againstenzymatic or hydrolytic degradation in order to increase their halflives in circulation, and make them more selective for a specific opioidreceptor subclass to avoid deleterious and potentially life-threateningside effects. However, even with such stable and protease-resistantanalogs, oral delivery is not feasible due to low bioavailability.

It is accordingly an object of the present invention to provide atherapeutically effective oral pharmaceutical composition for reliablydelivering pharmaceutical peptides, e.g., physiologically active peptideagents having analgesic and/or cardiovascular activity.

It is a further object of the invention to provide therapeutic methodsfor enhancing the bioavailability of such peptides.

In one aspect, the invention provides a pharmaceutical composition forthe oral delivery of a peptide having analgesic and/or cardiovascularactivity. The composition comprises (A) a therapeutically effectiveamount of an active peptide component (as described below) and (B) atleast one absorption enhancer effective to promote bioavailability ofthe peptide or (C) at least one pharmaceutically acceptable pH-loweringagent, wherein the pH-lowering agent is present in the pharmaceuticalcomposition in a quantity which, if the composition were added to 10milliliters of 0.1M aqueous sodium bicarbonate solution, would besufficient to lower the pH of the solution to no higher than 5.5. In afurther embodiment (D), the pharmaceutical composition may include boththe absorption enhancer and the pH-lowering agent. In yet a furtherembodiment (E), the pharmaceutical composition of (A), (B), (C) or (D)may also include an acid-resistant protective vehicle effective totransport the pharmaceutical composition through the stomach of apatient while preventing contact between the active peptide componentand stomach proteases.

In another aspect, the invention is directed to a pharmaceuticalcomposition for the oral delivery of a peptide having analgesic and/orcardiovascular activity, wherein the composition comprises (A) atherapeutically effective amount of an active peptide component (asdescribed below) and (B) at least one pharmaceutically acceptablepH-lowering agent, wherein the pH-lowering agent is present in thepharmaceutical composition in a quantity which, if the composition wereadded to 10 milliliters of 0.1M aqueous sodium bicarbonate solution,would be sufficient to lower the pH of the solution to no higher than5.5. The pharmaceutical composition may optionally additionally compriseat least one additional component selected from the group consisting of(C) at least one absorption enhancer effective to promotebioavailability of the peptide; and (D) an acid-resistant protectivevehicle effective to transport the pharmaceutical composition throughthe stomach of a patient while preventing contact between the activepeptide component and stomach proteases.

The active peptide component for inclusion in the formulation of theinvention is selected from among one or more of the following:

(A) A peptide of formula I

wherein R¹ is selected from the group consisting of hydrogen, C₁-C₇branched or unbranched alkyl, phenyl, hydroxyphenyl, methoxyphenyl,benzyl, hydroxybenzyl, methoxybenzyl, aminobenzyl, amidobenzyl,carboxybenzyl, carboxymethylbenzyl, cyanobenzyl, fluorobenzyl,chlorobenzyl, bromobenzyl, iodobenzyl, mercaptobenzyl, and nitrobenzyl;R² is hydrogen, methyl, ethyl; orR¹ and R², taken together with the carbon atom to which they areattached, form a cycloalkyl ring containing 3-5 carbon atoms;X is selected from the group consisting of C═O, N—H, CH₂, —O—, C═S and—S—;Y is selected from the group C═O, N—H, CH₂, —O—, C═S and —S—; orX and Y, taken together, represent an olefin linkage wherein X and Yeach have a hydrogen atom attached thereto in a cis or transconfiguration; andn is 1-7;(B) a peptide of formula II:

H-Tyrosine-A-Phenylalanine-B—NH2

wherein:

A is selected from the group consisting of D-α-amino acids;

B is selected from the group consisting of α-amino acids; and

the overall net positive charge of the peptide is +2 or greater,

(C) A peptide of formula III

wherein

R¹ is selected from

-   -   (i) linear or branched C₁-C₆ alkyl;    -   (ii) C₁-C₆ alkoxy;

R² is selected from

-   -   (i) hydrogen;    -   (ii) linear or branched C₁-C₆ alkyl;    -   (iii) C₁-C₆ alkoxy;

R³ and R⁴ is each and independently selected from

-   -   (i) hydrogen;    -   (ii) linear or branched C₁-C₆ alkyl;

wherein m=1-3;

R⁵, R⁶, R⁷, R⁸ and R9 is each independently selected from

(i) hydrogen;

(ii) halogen, where “halogen” encompasses chloro, fluoro, bromo andiodo; and

(iii) linear or branched C₁-C₆ alkyl; and

n is an integer of from 1 to 5;

(D) A peptide of formula IV

Tyrosine-D-alanine-Xaa-Glycine-Tyrosine-Proline-Serine-NH₂

wherein Xaa is L- or D-dimethylphenylalanine;(E) A peptide of formula V

Tyrosine-D-alanine-Xaa-Glutamic Acid-Valine-Valine-Glycine-NH₂

wherein Xaa is L- or D-dimethylphenylalanine;(F) An enkephalin peptide; and(G) A peptide linked to a DMT-Tic-pharmacophore.

In another aspect, the invention provides a pharmaceutical compositionfor oral delivery of a compound having analgesic and/or cardiovascularactivity, wherein the composition comprises: (A) a therapeuticallyeffective amount of an active compound which is an agonist or a partialagonist of vanilloid receptor VR1; and (B) at least one absorptionenhancer effective to promote bioavailability of the compound or (C) atleast one pharmaceutically acceptable pH-lowering agent, wherein thepH-lowering agent is present in the pharmaceutical composition in aquantity which, if the composition were added to 10 milliliters of 0.1Maqueous sodium bicarbonate, would be sufficient to lower the pH of thesolution to no higher than 5.5. In a further embodiment (D), thepharmaceutical composition may include both the absorption enhancer andthe pH-lowering agent. In yet another embodiment (E), the pharmaceuticalcomposition of (A), (B), (C) or (D) may also include an acid-resistantprotective vehicle effective to transport the pharmaceutical compositionthrough the stomach of a patient while preventing contact between theactive peptide component and stomach proteases.

In a further aspect, any of the pharmaceutical compositions of theinvention may additionally comprise a water-soluble barrier separatingthe pH-lowering agent from the protective vehicle.

In another aspect of the invention, any of the pharmaceuticalcompositions may comprise granules containing a pharmaceutical binderand, uniformly dispersed in the binder, at least one of the pH-loweringagent, the absorption enhancer and the peptide having analgesic and/orcardiovascular activity.

Additional aspects of the invention relate to therapeutic methodsinvolving oral administration of therapeutically effective amounts ofpharmaceutical compositions as described herein.

In one aspect, the invention provides a method for enhancing the oralbioavailability of a compound comprising a peptide having analgesic orcardiovascular activity. The method comprises orally delivering apharmaceutical composition that combines the compound with at least oneabsorption enhancer effective to promote bioavailability of thecompound, or combining the compound with at least one pH-lowering agent,wherein the pH-lowering agent is present in a quantity which, if thecomposition were added to 10 milliliters of 0.1 M aqueous sodiumbicarbonate solution, would be sufficient to lower the pH of thesolution to no higher than 5.5. The method may also comprise orallydelivering a pharmaceutical composition that combines the compound withat least one absorption enhancer in combination with at least onepH-lowering agent. The method may also comprise transporting any of theabove pharmaceutical compositions through the stomach of a patient by anacid-resistant protective vehicle to prevent contact between thepharmaceutical composition and stomach proteases.

In another aspect, the invention provides a method for stimulating a mu,delta or kappa-opioid receptor in a mammal in need of such stimulation,wherein the method comprises orally administering to the mammal aneffective opioid receptor stimulating amount of one or more of thepharmaceutical compositions described herein.

In an additional aspect, the invention provides a method for relievingpain comprising orally administering to a patient in need of pain reliefan effective pain-relieving amount of one or more of the pharmaceuticalcompositions described herein.

In a further aspect, the invention provides a method for improvingmyocardial contractile force. The method comprises orally administeringto a patient in need of such improvement an effective contractileforce-increasing amount of one or more of the pharmaceuticalcompositions described herein containing a therapeutically effectiveamount of a dermorphin analog or a prodrug thereof.

In another aspect, the invention provides a method for improving cardiacperformance of a heart before, during and/or after cardiactransplantation. The method comprises orally administering to a patientin need of such improved cardiac performance an effective cardiacperformance-improving amount of one or more of the pharmaceuticalcompositions described herein containing a therapeutically effectiveamount of a dermorphin analog or a prodrug thereof.

In the context of the invention, prodrugs of any of the above-describedactive peptides useful in forming the compositions of the invention maybe used in place of the corresponding peptide, as these will alsoincrease the serum levels of the peptide. The prodrug is converted invivo to the desired active compound by a well-known mechanism. Thepharmaceutical industry frequently uses salt or ester prodrugs todeliver a large number of pharmaceutical agents. It is, in fact, rare inthe pharmaceutical industry that particular active ingredients that areto be delivered to the bloodstream of a patient are not formulated (intheir dosage form) as a prodrug which, as noted above, is subsequentlyconverted in vivo to the desired active compound by such well-knownmechanism. The term “prodrug” as used herein is meant to include onlythose compounds which, when converted in vivo, deliver one or more ofthe active peptides described and claimed herein to the bloodstream of asubject to whom they are administered. A variety of well-known prodrugforms of various functional groups that may appear on the active peptidecompounds for use in the invention are set forth in A Textbook of DrugDesign and Development, Bundgaard and Krosgaard-Larsen, Ed., (HarwookAcademic Publishers GmfH, Chur, Switzerland) 1991 which is incorporatedherein by reference.

Other features and advantages of the present invention will becomeapparent from the following detailed description of the invention.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 provides, in graphical form, pharmacokinetic profiles followingadministration of unformulated Dmt-DALDA and Dmt-DALDA formulated withan absorption enhancer and pH-lowering agent by duodenal injection inanesthetized rats.

FIG. 2A and FIG. 2B provide, in graphical form, pharmacokinetic profilesfollowing administration to beagle dogs of salmon calcitonin (sCT) plusDmt-DALDA with citric acid and lauroyl carnitine, in a solid dosagecapsule formulation, either without (FIG. 2A) or with (FIG. 2B) anenteric coating.

DETAILED DESCRIPTION OF THE INVENTION

In accordance with the invention, patients in need of treatment withpeptides having analgesic and/or cardiovascular activity are providedwith an oral pharmaceutical composition thereof (at appropriate dosage),preferably but not necessarily in tablet or capsule form of an ordinarysize in the pharmaceutical industry. The dosages and frequency ofadministering the products are discussed in more detail below. Patientswho may benefit are any who suffer from disorders that respond favorablyto increased levels of a peptide-containing compound. For example, oraladministration of dermorphin, deltorphin and/or enkephalin peptideanalogs in accordance with the invention may be used to treat patientsin need of pain relief, or those with conditions warranting improvedcardiac performance, e.g., by improving myocardial contractile force.

Without intending to be bound by theory, the pharmaceutical compositionsof the invention are believed to overcome a series of different andunrelated natural barriers to bioavailability. Various components of thepharmaceutical compositions act to overcome different barriers bymechanisms appropriate to each, and result in synergistic effects on thebioavailability of a peptide active ingredient.

The peptide active compound may be administered orally. In accordancewith the invention, proteolytic degradation of the peptide by stomachproteases (most of which are active in the acid pH range) and intestinalor pancreatic proteases (most of which are active in the neutral tobasic pH range) is reduced. Solubility enhancers aid passage of thepeptide active agent through the intestinal epithelial barrier.

Again, without intending to be bound by theory, it appears that, inaccordance with one embodiment of the present invention, the peptide istransported through the stomach under the protection of an appropriateacid-resistant protective vehicle for substantially preventing contactbetween the active peptide and any stomach proteases capable ofdegrading it. Once the pharmaceutical composition of the inventionpasses through the stomach and enters the intestinal region where basicto neutral pH predominates, and where proteases tend to have basic toneutral pH optima, the enteric coating or other vehicle releases thepeptide and acid (in close proximity to each other).

The pH-lowering agent is believed to lower the local intestinal pH(where the active agent has been released) to levels below the optimalrange for many intestinal proteases. This decrease in pH reduces theproteolytic activity of the intestinal proteases, thus affordingprotection to the peptide from potential degradation. The activity ofthese proteases is diminished by the temporarily acidic localenvironment provided by the invention. It is preferred that sufficientacid be provided that local intestinal pH is lowered temporarily to 5.5or below, preferably 4.7 or below and more preferably 3.5 or below. Thesodium bicarbonate test described below (in the section below captioned“the pH-Lowering Agent”) is indicative of the required acid amount.Preferably, conditions of reduced intestinal pH persist for a timeperiod sufficient to protect the peptide agent from proteolyticdegradation until at least some of the peptide agent has had anopportunity to cross the intestinal wall into the bloodstream. Theabsorption enhancers of the invention synergistically promote peptideabsorption into the blood while conditions of reduced proteolyticactivity prevail.

The mechanism by which the invention is believed to accomplish the goalof enhanced bioavailability is aided by having active components of thepharmaceutical composition released together as simultaneously aspossible. To this end, it is preferred to keep the volume of entericcoating as low as possible consistent with providing protection fromstomach proteases. Thus enteric coating is less likely to interfere withpeptide release, or with the release of other components in close timeproximity with the peptide. The enteric coating should normally add lessthan 30% to the weight of the remainder of pharmaceutical composition(i.e., the other components of the composition excluding entericcoating). Preferably, it is less than 20% and, more preferably, theenteric coating adds between 10% and 20% to the weight of the uncoatedingredients.

The absorption enhancer which may be a solubility enhancer and/ortransport enhancer (as described in more detail below) aids transport ofthe peptide agent from the intestine to the blood, and may promote theprocess so that it better occurs during the time period of reducedintestinal pH and reduced intestinal proteolytic activity. Many surfaceactive agents may act as both solubility enhancers and transport(uptake) enhancers. Again without intending to be bound by theory, it isbelieved that enhancing solubility provides (1) a more simultaneousrelease of the active components of the invention into the aqueousportion of the intestine, (2) better solubility of the peptide in, andtransport through, a mucous layer along the intestinal walls. Once thepeptide active ingredient reaches the intestinal walls, an uptakeenhancer provides better transport through the brush border membrane ofthe intestine into the blood, via either transcellular or paracellulartransport. As discussed in more detail below, many preferred compoundsmay provide both functions. In those instances, preferred embodimentsutilizing both of these functions may do so by adding only oneadditional compound to the pharmaceutical composition. In otherembodiments, separate absorption enhancers may provide the two functionsseparately.

Each of the preferred ingredients of the pharmaceutical composition ofthe invention is separately discussed below. Combinations of multiplepH-lowering agents, or multiple enhancers can be used as well as usingjust a single pH-lowering agent and/or single enhancer. Some preferredcombinations are also discussed below.

In one embodiment of the present invention, the pharmaceuticalcomposition for oral delivery may comprise the peptide or compound incombination with an absorption enhancer and a pH-lowering agent, alongwith an enteric coating to transport the ingredients through the stomachof a patient while preventing contact between the pharmaceuticalcomposition and stomach proteases.

In another embodiment, it has been shown from experiments with severalpeptides that a pharmaceutical composition for oral delivery thatcomprises only a peptide with a pH-lowering agent provides a significantincrease in bioavailability compared to that offered by the peptidetaken alone.

In yet another embodiment, it has been shown from experimentation with avariety of peptides that a pharmaceutical composition for oral deliverycomprising only a peptide and an absorption enhancer provides asignificant increase in bioavailability, compared to that of the peptidetaken alone.

Peptide Active Ingredients

Peptide active ingredients which may benefit from oral delivery inaccordance with the invention include peptides having analgesic orcardiovascular activity. Several non-limiting examples of such peptidesare described below, however, as one of ordinary skill in this art wouldrecognize, various additional peptides, analogs and/or prodrugs may besubstituted for the peptides described herein in the formulationsprepared according to the invention.

In a first embodiment, a peptide for use with the invention may be adermorphin analog, or a prodrug thereof, of formula I

wherein R¹ is selected from the group consisting of hydrogen, C₁-C₇branched or unbranched alkyl, phenyl, hydroxyphenyl, methoxyphenyl,benzyl, hydroxybenzyl, methoxybenzyl, aminobenzyl, amidobenzyl,carboxybenzyl, carboxymethylbenzyl, cyanobenzyl, fluorobenzyl,chlorobenzyl, bromobenzyl, iodobenzyl, mercaptobenzyl, and nitrobenzyl;R² is hydrogen, methyl, ethyl; orR¹ and R², taken together with the carbon atom to which they areattached, form a cycloalkyl ring containing 3-5 carbon atoms;X is selected from the group consisting of C═O, N—H, CH₂, —O—, C═S and—S—;Y is selected from the group C═O, N—H, CH₂, —O—, C═S and —S—; orX and Y, taken together, represent an olefin linkage wherein X and Yeach have a hydrogen atom attached thereto in a cis or transconfiguration; andn is 1-7.

Useful dermorphin analogs falling within the scope of formula I include,but are not limited to:

(A) H-Tyrosine-D-Norvaline-Phenylalanine-Ornithine-NH₂; (B)H-Tyrosine-D-Norleucine-Phenylalanine-Ornithine-NH₂;

(C) H-Tyrosine-D-Arginine-Phenylalanine-α,γ-diaminobutyric acid-NH₂;

(D) H-Tyrosine-D-Arginine-Phenylalanine-Lysine-NH₂; (E)H-Lysine-Tyrosine-D-Arginine-Phenylalanine-Lysine-NH₂; and

(F) N^(α)-amidino-Tyrosine-D-arginine-Phenylalanine-Methyl-β-alanine-OH.

In a preferred embodiment, the peptide of the invention isH-Tyrosine-D-Arginine-Phenylalanine-Lysine-NH₂ (“DALDA”).

In another embodiment, the peptide for use with the invention may be adermorphin analog of formula II, or a prodrug thereof:

H-Tyrosine-A-Phenylalanine-B—NH₂

wherein:

A is selected from the group consisting of D-α-amino acids;

B is selected from the group consisting of α-amino acids; and

the overall net positive charge of the peptide is +2 or greater

D-α-amino acids useful in forming the compositions of the inventioninclude, but are not limited to, D-norvaline, D-norleucine, D-arginine,D-alanine, D-valine, D-isoleucine, D-leucine, D-serine, D-phenylalanineand D-α,γ-diaminobutyric acid. Alpha-amino acids useful in forming thecompositions of the invention include, but are not limited tophenylalanine, para-fluoro phenylalanine, ornithine, α,γ-diaminobutyricacid, lysine, norvaline, arginine, α,β-diaminopropionic acid andhomolysine. In a preferred embodiment, the overall net positive chargeof the peptide may be +2 or +3.In a further embodiment, the peptide may be a DALDA derivative offormula III:

wherein

R¹ is selected from

-   -   (i) linear or branched C₁-C₆ alkyl;    -   (ii) C₁-C₆ alkoxy,

R² is selected from

-   -   (i) hydrogen;    -   (ii) linear or branched C₁-C₆ alkyl;    -   (iii) C₁-C₆ alkoxy;

R³ and R⁴ is each and independently selected from

-   -   (i) hydrogen;    -   (ii) linear or branched C₁-C₆ alkyl;

wherein m=1-3;

R⁵, R⁶, R⁷, R⁸ and R9 is each independently selected from

(i) hydrogen;

(ii) halogen, where “halogen” encompasses chloro, fluoro, bromo andiodo; and

(iii) linear or branched C₁-C₆ alkyl; and

n is an integer of from 1 to 5.

More particularly, in one embodiment of the above-described peptide,R¹ is a linear C₁-C₆ alkyl;

R² is a linear C₁-C₆ alkyl or hydrogen;

R³ and R⁴ is each and independently selected from a straight C₁-C₆ alkylor hydrogen;

R⁵, R⁶, R⁷, R⁸ and R⁹ is each and independently selected from

-   -   (i) hydrogen;    -   (ii) a halogen selected from chloro, fluoro, bromo and iodo; and    -   (iii) linear or branched C₁-C₆ alkyl, and

n is an integer from 1 to 5.

In an alternate version of the subject embodiment,

R¹ is CH₃;

R² is hydrogen or CH₃;

R³ and R⁴ are both hydrogen;

R⁵, R⁶, R⁷, R⁸ and R⁹ are all hydrogen; and

n=4.

In a preferred embodiment, the dermorphin analog is a peptiderepresented by the formula:

H-2,6-dimethyltyrosine-D-Arginine-Phenylalanine-Lysine-NH₂.(“DMT-DALDA”)

In an additional embodiment of the invention, the peptide is adermorphin analog of formula IV:

Tyrosine-D-alanine-Xaa-Glycine-Tyrosine-Proline-Serine-NH₂

wherein Xaa is L- or D-dimethylphenylalanine.In a further embodiment of the invention, the peptide for use with theinvention is a deltorphin analog of formula V:

Tyrosine-D-alanine-Xaa-Glutamic Acid-Valine-Valine-Glycine-NH₂

wherein Xaa is L or D-dimethylphenylalanine.

An alternate embodiment of the invention involves the inclusion ofcompounds having analgesic and/or cardiovascular activity which,although not peptides, display characteristics which are similar theretoand which are subject to many of the same considerations with regard totransport and adsorption as the peptides described herein. Thesecompounds are agonists or partial agonists of the vanilloid receptorVR1. Examples of these compounds include, but are not limited to:

-   (i)    N-[2-(3,4-dimethylbenzyl)-3-(pivaloyloxy)propyl]-N′-[4-(methylsulfonylamino)benzyl]thiourea;    and-   (ii)    N-(4-tert-butylbenzyl)-N′-[3-methoxy-4-(methylsulfonylamino)benzyl]thiourea.    In an additional embodiment of the invention, the peptide is an    enkephalin peptide, or a prodrug thereof. Examples of such    enkephalin peptides include, but are not limited to:

(i) H-Tyrosine-Glycine-Glycine-Phenylalanine-Methionine-OH;

(ii) H-Tyrosine-Glycine-Glycine-Phenylalanine-Leucine-OH;

(iii) H-Tyrosine-D-alanine-Glycine-N-methyl-phenylalanine-Glycine-ol;and

(iv) analogs thereof.

In still another embodiment, the peptide may be linked to aDMT-Tic-Pharmacaphore having the structure

H-2′,6′-dimethyl-L-tyrosine-1,2,3,4-tetrahydroisoquinoline-3-carboxylicacid.

Peptides for use in the invention include, but are not limited to thoseselected from the group consisting of

-   -   (i) H-DMT-Tic-Glycine-NH-Benzyl; and    -   (ii) H-DMT-Tic-NH—CH(CH₂—COOH)-1-H-benzimidazole-2-yl.

The peptides having analgesic and/or cardiovascular activity for use inthe invention may be prepared in accordance with Examples 2 and 3 ofU.S. Pat. No. 5,602,100 to Brown et al., which is incorporated herein byreference. Example 2 of the subject patent teaches the method of peptidesynthesis. Peptides containing c-terminal free acids can be synthesizedby linking BOC amino acids using a chloro methyl resin [Merrifieldresin], 1% cross linked, 100-200 mesh obtained from PeptidesInternational [Lousiville, Ky.]. Example 3 describes methodology for usein purifying the resultant peptides. In particular, a preferred peptidefor use in the invention, i.e., Dmt-DALDA, may be prepared as shown inExample 1 of U.S. Pat. No. 6,703,483 to Schiller, which is alsoincorporated by reference.

Compounds having analgesic and/or cardiovascular activity which areuseful in the invention further include agonists or partial agonists ofvanilloid receptor VR1. Methods for preparing these compounds are setforth in, for example, International Patent Publications WO 02/16318 andWO 02/16319 of Suh, et al., both dated Feb. 28, 2002. Both of thesepublications are incorporated herein by reference.

The pH-Lowering Agent

The total amount of the pH-lowering agent to be administered with eachadministration of the pharmaceutical composition should preferably be anamount which, when it is released into the intestine, is sufficient tolower the local intestinal pH substantially below the pH optima forproteases found there. The quantity required will necessarily vary withseveral factors including the type of pH-lowering agent used (discussedbelow) and the equivalents of protons provided by a given pH-loweringagent. In practice, the amount required to provide good bioavailabilityis an amount which, when added to a solution of 10 milliliters of 0.1 Msodium bicarbonate, lowers the pH of that sodium bicarbonate solution tono higher than 5.5, and preferably no higher than 4.7, most preferablyno higher than 3.5. Enough acid to lower pH, in the foregoing test, toabout 2.8 may been used in some embodiments. Preferably at least 300milligrams, and more preferably at least 400 milligrams of thepH-lowering agent are used in the pharmaceutical composition of theinvention. The foregoing preferences relate to the total combined weightof all pH-lowering agents where two or more of such agents are used incombination. The oral formulation should not include an amount of anybase which, when released together with the pH-lowering compound, wouldprevent the pH of the above-described sodium bicarbonate test fromdropping to 5.5 or below.

The pH-lowering agent of the invention may be any pharmaceuticallyacceptable compound that is not toxic in the gastrointestinal tract andis capable of either delivering hydrogen ions (a traditional acid) or ofinducing higher hydrogen ion content from the local environment. It mayalso be any combination of such compounds. It is preferred that at leastone pH-lowering agent used in the invention have a pKa no higher than4.2, and preferably no higher than 3.0. It is also preferred that the pHlowering agent have a solubility in water of at least 30 grams per 100milliliters of water at room temperature.

Examples of compounds that induce higher hydrogen ion content includealuminum chloride and zinc chloride. Pharmaceutically acceptabletraditional acids include, but are not limited to acid salts of aminoacids (e.g. amino acid hydrochlorides) or derivatives thereof. Examplesof these are acid salts of acetylglutamic acid, alanine, arginine,asparagine, aspartic acid, betaine, carnitine, carnosine, citrulline,creatine, glutamic acid, glycine, histidine, hydroxylysine,hydroxyproline, hypotaurine, isoleucine, leucine, lysine,methylhistidine, norleucine, ornithine, phenylalanine, proline,sarcosine, serine, taurine, threonine, tryptophan, tyrosine and valine.

Other examples of useful pH-lowering compounds include carboxylic acidssuch as acetylsalicylic, acetic, ascorbic, citric, fumaric, glucuronic,glutaric, glyceric, glycocolic, glyoxylic, isocitric, isovaleric,lactic, maleic, oxaloacetic, oxalosuccinic, propionic, pyruvic,succinic, tartaric, valeric, and the like.

Other useful pH-lowering agents that might not usually be called “acids”in the art, but which may nonetheless be useful in accordance with theinvention are phosphate esters (e.g., fructose 1,6 diphosphate, glucose1,6 diphosphate, phosphoglyceric acid, and diphosphoglyceric acid).CARBOPOL.®. (Trademark BF Goodrich) and polymers such as polycarbophilmay also be used to lower pH.

Any combination of pH lowering agent that achieves the required pH levelof no higher than 5.5 in the sodium bicarbonate test discussed above maybe used. One preferred embodiment utilizes, as at least one of thepH-lowering agents of the pharmaceutical composition, an acid selectedfrom the group consisting of citric acid, tartaric acid and an acid saltof an amino acid.

When DMT-DALDA is the peptide active agent, certain ratios ofpH-lowering agent to DMT-DALDA have proven especially effective. It ispreferred that the weight ratio of pH-lowering agent to DMT-DALDA exceed40:1, preferably 400:1 and most preferably 4000:1.

The Absorption Enhancer

The absorption enhancers are preferably present in a quantity thatconstitutes from 0.1 to 20.0 percent by weight, relative to the overallweight of the pharmaceutical composition (exclusive of the entericcoating). Preferred absorption enhancers are surface active agents whichact both as solubility enhancers and uptake enhancers. Genericallyspeaking, “solubility enhancers” improve the ability of the componentsof the invention to be solubilized in either the aqueous environmentinto which they are originally released or into the lipophilicenvironment of the mucous layer lining the intestinal walls, or both.“Transport (uptake) enhancers” (which are frequently the same surfaceactive agents used as solubility enhancers) are those which facilitatethe ease by which peptide agents cross the intestinal wall.

One or more absorption enhancers may perform one function only (e.g.,solubility), or one or more absorption enhancers may perform the otherfunction only (e.g., uptake), within the scope of the invention. It isalso possible to have a mixture of several compounds some of whichprovide improved solubility, some of which provide improved uptakeand/or some of which perform both. Without intending to be bound bytheory, it is believed that uptake enhancers may act by (1) increasingdisorder of the hydrophobic region of the membrane exterior ofintestinal cells, allowing for increased transcellular transport; or (2)leaching membrane proteins resulting in increased transcellulartransport; or (3) widening pore radius between cells for increasedparacellular transport. Surface active agents are believed to be usefulboth as solubility enhancers and as uptake enhancers. For example,detergents are useful in (1) solubilizing all of the active componentsquickly into the aqueous environment where they are originally released,(2) enhancing lipophilicity of the components of the invention,especially the peptide active agent, aiding its passage into and throughthe intestinal mucus, (3) enhancing the ability of the normally polarpeptide active agent to cross the epithelial barrier of the brush bordermembrane; and (4) increasing transcellular or paracellular transport asdescribed above.

When surface active agents are used as the absorption enhancers, it ispreferred that they be free flowing powders for facilitating the mixingand loading of capsules during the manufacturing process. Because ofinherent characteristics of certain peptides (e.g., their isoelectricpoint, molecular weight, amino acid composition, etc.) certain surfaceactive agents interact best with certain peptides. Indeed, some canundesirably interact with the charged portions of certain peptides andthus prevent their absorption, thus undesirably resulting in decreasedbioavailability. It is preferred, when trying to increase thebioavailability of peptides that any surface active agent used as anabsorption enhancer be selected from the group consisting of (i) anionicsurface active agents that are cholesterol derivatives (e.g., bileacids), (ii) cationic surface agents (e.g., acyl carnitines,phospholipids and the like), (iii) non-ionic surface active agents, and(iv) mixtures of anionic surface active agents (especially those havinglinear hydrocarbon regions) together with negative charge neutralizers.Negative charge neutralizers include but are not limited to acylcarnitines, cetyl pyridinium chloride, and the like. Acyl carnitines(e.g., lauroyl carnitine) are particularly good absorption enhancers. Itis also preferred that the absorption enhancer be soluble at acid pH,particularly in the 3.0 to 5.0 range.

To reduce the likelihood of side effects, preferred detergents, whenused as the absorption enhancers of the invention, are eitherbiodegradable or reabsorbable (e.g. biologically recyclable compoundssuch as bile acids, phospholipids, and/or acyl carnitines), preferablybiodegradable. Acylcarnitines are believed particularly useful inenhancing paracellular transport.

Absorption enhancers may also include: (a) salicylates such as sodiumsalicylate, 3-methoxysalicylate, 5-methoxysalicylate and homovanilate;(b) bile acids such as taurocholic, tauorodeoxycholic, deoxycholic,cholic, glycholic, lithocholate, chenodeoxycholic, ursodeoxycholic,ursocholic, dehydrocholic, fusidic, etc.; (c) non-ionic surfactants suchas polyoxyethylene ethers (e.g. Brij 36T, Brij 52, Brij 56, Brij 76,Brij 96, Texaphor A6, Texaphor A14, Texaphor A60 etc.), p-t-octyl phenolpolyoxyethylenes (Triton X-45, Triton X-100, Triton X-114, Triton X-305etc.) nonylphenoxypoloxyethylenes (e.g. Igepal CO series),polyoxyethylene sorbitan esters (e.g. Tween-20, Tween-80 etc.); (d)anionic surfactants such as dioctyl sodium sulfosuccinate; (e)lyso-phospholipids such as lysolecithin andlysophosphatidylethanolamine; (f) acylcarnitines, acylcholines and acylamino acids such as lauroylcarnitine, myristoylcarnitine,palmitoylcarnitine, lauroylcholine, myristoylcholine, palmitoylcholine,hexadecyllysine, N-acylphenylalanine, N-acylglycine etc.; g) watersoluble phospholipids such as diheptanoylphosphatidylcholine,dioctylphosphatidylcholine etc.; (h) medium-chain glycerides which aremixtures of mono-, di- and triglycerides containing medium-chain-lengthfatty acids (caprylic, capric and lauric acids); (i)ethylene-diaminetetraacetic acid; (j) cationic surfactants such ascetylpyridinium chloride; (k) fatty acid derivatives of polyethyleneglycol such as Labrasol, Labrafac, etc.; and (l) alkylsaccharides suchas lauryl maltoside, lauroyl sucrose, myristoyl sucrose, palmitoylsucrose, etc.

In some preferred embodiments, and without intending to be bound bytheory, cationic ion exchange agents (e.g. detergents) are included toprovide solubility enhancement by another possible mechanism. Inparticular, they may prevent the binding of the peptide active agents tomucus. Preferred cationic ion exchange agents include protamine chlorideor any other polycation.

Other Optional Ingredients

It is preferred that a water-soluble barrier separate the pH-loweringagent from the acid resistant protective vehicle. A conventionalpharmaceutical capsule may, for example, be used for the purpose ofproviding this barrier. Many water soluble barriers are known in the artand include, but are not limited to, hydroxypropyl methylcellulose andconventional pharmaceutical gelatins.

In some preferred embodiments, another peptide (such as albumin, casein,soy protein, other animal or vegetable proteins and the like) isincluded to reduce non-specific adsorption (e.g., binding of peptide tothe intestinal mucus barrier) thereby lowering the necessaryconcentration of the expensive peptide active agent. When added, thepeptide is preferably from 1.0 to 10.0 percent by weight relative to theweight of the overall pharmaceutical composition (excluding protectivevehicle). Preferably, this second peptide is not physiologically activeand is most preferably a food peptide such as soy bean peptide or thelike. Without intending to be bound by theory, this second peptide mayalso increase bioavailability by acting as a protease scavenger thatdesirably competes with the peptide active agent for proteaseinteraction. The second peptide may also aid the active compound'spassage through the liver.

All pharmaceutical compositions of the invention may optionally alsoinclude common pharmaceutical diluents, glycants, lubricants, gelatincapsules, preservatives, colorants and the like in their usual knownsizes and amounts.

The Protective Vehicle

Any carrier or vehicle that protects the peptide active agent fromstomach proteases and then dissolves so that the other ingredients ofthe invention may be released in the intestine is suitable. Many suchenteric coatings are known in the art, and are useful in accordance withthe invention. Examples include cellulose acetate phthalate,hydroxypropyl methylethylcellulose succinate, hydroxypropylmethylcellulose phthalate, carboxyl methylethylcellulose and methacrylicacid-methyl methacrylate copolymer. In some embodiments, the activepeptide, absorption enhancers such as solubility and/or uptakeenhancer(s), and pH-lowering compound(s), are included in a sufficientlyviscous protective syrup to permit protected passage of the componentsof the invention through the stomach.

Suitable enteric coatings for protecting the peptide agent from stomachproteases may be applied, for example, to capsules after the remainingcomponents of the invention have been loaded within the capsule. Inother embodiments, enteric coating is coated on the outside of a tabletor coated on the outer surface of particles of active components whichare then pressed into tablet form, or loaded into a capsule, which isitself preferably coated with an enteric coating.

It is very desirable that all components of the invention be releasedfrom the carrier or vehicle, and solubilized in the intestinalenvironment as simultaneously as possible. It is preferred that thevehicle or carrier release the active components in the small intestinewhere uptake enhancers that increase transcellular or paracellulartransport are less likely to cause undesirable side effects than if thesame uptake enhancers were later released in the colon. It isemphasized, however, that the present invention is believed effective inthe colon as well as in the small intestine. Numerous vehicles orcarriers, in addition to the ones discussed above, are known in the art.It is desirable (especially in optimizing how simultaneously thecomponents of the invention are released) to keep the amount of entericcoating low. Preferably, the enteric coating adds no more than 30% tothe weight of the remainder of pharmaceutical composition (the“remainder” being the pharmaceutical composition exclusive of entericcoating itself). More preferably, it adds less than 20%, especially from12% to 20% to the weight of the uncoated composition. The entericcoating preferably should be sufficient to prevent breakdown of thepharmaceutical composition of the invention in 0.1N HCl for at least twohours, then capable of permitting complete release of all contents ofthe pharmaceutical composition within thirty minutes after pH isincreased to 6.3 in a dissolution bath in which said composition isrotating at 100 revolutions per minute.

Other Preferences

It is preferred that the weight ratio of pH-lowering agent(s) toabsorption enhancer(s) be between 3:1 and 20:1, preferably 4:1-12:1, andmost preferably 5:1-10:1. The total weight of all pH-lowering agents andthe total weight of all absorption enhancers in a given pharmaceuticalcomposition is included in the foregoing preferred ratios. For example,if a pharmaceutical composition includes two pH-lowering agents andthree absorption enhancers, the foregoing ratios will be computed on thetotal combined weight of both pH-lowering agents and the total combinedweight of all three absorption enhancers.

It is preferred that the pH-lowering agent, the peptide active agent andthe absorption enhancer (whether single compounds or a plurality ofcompounds in each category) be uniformly dispersed in the pharmaceuticalcomposition. In one embodiment, the pharmaceutical composition comprisesgranules that include a pharmaceutical binder having the peptide activeagent, the pH-lowering agent and the absorption enhancer uniformlydispersed within said binder. Preferred granules may also consist of anacid core, surrounded by a uniform layer of organic acid, a layer ofenhancer and a layer of peptide that is surrounded by an outer layer oforganic acid. Granules may be prepared from an aqueous mixtureconsisting of pharmaceutical binders such as polyvinyl pyrrolidone orhydroxypropyl methylcellulose, together with the pH-lowering agents,absorption enhancers and peptide active agents of the invention.

Manufacturing Process

A preferred pharmaceutical composition of the invention includes a sizeOO gelatin or HPMC (hydroxypropylmethyl cellulose) capsule filled with0.25 mg of the active peptide component with analgesic and/orcardiovascular activity, 400 mg of granular citric acid (available forexample from Archer Daniels Midland Corp.) and 50 mg lauroyl carnitine(SIGMA)

All of the ingredients are preferably for eventual insertion into thegelatin or HPMC capsule, and are preferably powders which may be addedto a blender in any order. Thereafter, the blender is run for about fiveminutes until the powders are thoroughly intermixed. Then the mixedpowders are loaded into the large end of the gelatine capsules. Theother end of the capsule is then added, and the capsule snapped shut.500 or more such capsules may be added to a coating device (e.g., VectorLDCS 20/30 Laboratory Development Coating System (available from VectorCorp., Marion, Iowa)). An enteric coating solution is made as follows.Weigh 500 grams of EUDRAGIT L30. D-55 (a methacrylic acid copolymer withmethacylic acid methyl ester, an enteric coating available from ROHMPharma Polymers Inc., Maidan, Mass.). Add 411 grams distilled water, 15grams triethyl citrate and 38 grams talc. This amount of coating will besufficient to coat about 500 size OO capsules.

The capsules are weighed and placed into the drum of the coatingmachine. The machine is turned on to rotate the drum (now containingcapsules) at 24-28 rpm. The temperature of inlet sprayer is preferablyabout 45.degree. C. Exhaust temperatures are preferably about 30.degree.C. Uncoated capsule temperature is preferably about 25.degree. C. Airflow is about 38 cubic feet per minute.

A tube from the machine is then inserted into the coating solutionprepared as discussed above. The pump is then turned on for feedingsolution into the coating device. Coating then proceeds automatically.The machine can be stopped at any time to weigh capsules to determine ifthe coating amount is sufficient. Usually coating is allowed to proceedfor 60 minutes. The pump is then turned off for about five minutes whilethe machine is still running to help dry the coated capsules. Themachine can then be turned off. The capsule coating is then complete,although it is recommended that the capsules be air dried for about twodays.

Because of the enhanced bioavailability provided by the presentinvention, the concentration of the expensive active peptide componentin the pharmaceutical preparation of the invention may be keptrelatively low. Specific formulation examples incorporating theDMT-DALDA peptide are set forth infra.

Treatment of Patients

It is preferred that a single capsule be used at each administrationbecause a single capsule best provides simultaneous release of thepolypeptide, pH-lowering agent and absorption enhancers. This is highlydesirable because the acid is best able to reduce undesirableproteolytic attack on the polypeptide when the acid is released in closetime proximity to release of the polypeptide. Near simultaneous releaseis best achieved by administering all components of the invention as asingle pill or capsule. However, the invention also includes, forexample, dividing the required amount of acid and enhancers among two ormore capsules which may be administered together such that they togetherprovide the necessary amount of all ingredients. “Pharmaceuticalcomposition,” as used herein includes a complete dosage appropriate to aparticular administration to a human patient regardless of how it issubdivided so long as it is for substantially simultaneousadministration.

For certain indications, it may be preferred to administer a first oralpharmaceutical composition in a capsule or tablet which does not containa protective acid stable vehicle, such that the components will berelatively rapidly released in the stomach and thus be available forimmediate pain relief, i.e., within about 10-20 minutes. Subsequently,additional capsules or tablets formulated according to the inventionwith a protective vehicle may then be administered, resulting inbioavailability in the intestine of the active ingredient after thelonger time interval that is required for gastric emptying, i.e.,typically around two hours.

In one embodiment of the invention, a sufficient amount of the peptide(or agonist or partial agonist of vanilloid receptor VR1) is included inthe oral formulation of the invention to achieve a serum level (i.e,C_(max)) of the peptide (or agonist or partial agonist) of from 200pg/ml to 20 ng/ml, and, more preferably, from 200 pg/ml to 2 ng/ml.Dosage levels of the active peptide (and/or the agonist or partialagonist) for achieving the above serum levels preferably range from 100μg to 10 mg and more preferably, from 100 μg to 1 mg. With respect toall of the dosages recommended herein, however, the attending clinicianshould monitor individual patient response and adjust the dosageaccordingly. Moreover, except where otherwise stated, the preferreddosage of the active compounds of the invention is identical for boththerapeutic and prophylactic purposes. The dosage for each activecomponent discussed herein is the same, regardless of the disease beingtreated (or prevented). Furthermore, except where otherwise indicated,the terms “compound” and “composition”, and any associated molecularstructure may include any possible stereoisomers thereof, in the form ofa racemic mixture or in optically active form.

Except where otherwise noted, or where apparent from context, dosagesherein refer to weight of active compounds unaffected by pharmaceuticalexcipients, diluents, carriers or other ingredients, although suchadditional ingredients are desirably included.

Experimental Results

The following examples are provided only for the purpose of illustrationand are not to be construed as limiting the invention in any manner.

Applicants have surprisingly discovered, through the use of in vivotests involving, respectively, rats and dogs, that administeringDmt-DALDA in the oral formulation described herein provides unexpectedimprovements in bioavailability of the subject peptide.

With regard to the first series of tests, i.e., on rats, the improvedeffect is demonstrated by comparing the curves for Formulated DALDA vs.Unformulated DALDA in FIG. 1. In the experiments represented in thesubject Figure, six anesthetized rats (which were color-coded as: red,white, blue, orange, green and yellow) were given 0.7 mL Dmt-DALDA (1.6mg/mL) with a syringe through a 27 gauge needle into the duodenum. Thisinjection procedure was followed due to the technical difficultyinherent in preparing capsules which can be swallowed by small animalsthe size of a rat. The intraduodanal injection, therefore, mimics therelease of the components of an enteric-coated capsule formulation whichwould pass through the esophagus and stomach and release its contents inthe duodenum. Three of the rats (red, white and blue) were givenUnformulated Dmt-DALDA in which there were no additional components(i.e., other than the Dmt-DALDA), while the other three rats (orange,green and yellow) were given Formulated Dmt-DALDA which included, inaddition to the Dmt-DALDA, 0.5M citric acid and lauroyl carnitine (10mg/ml). Samples of blood were taken from the carotid artery through anindwelling catheter before and 5, 15, 30, 60 and 120 minutes after theadministration of the respective formulations (i.e., Formulated andUnformulated). The blood samples were centrifuged and the resultingplasma supernatants were stored frozen at −20° C. The plasma sampleswere subsequently analyzed for Dmt-DALDA by high-performance liquidchromatography (HPLC) through a 50×4.6 mm polysulfoethyl-aspartamidecolumn with a mobile phase of 15.4 mM potassium phosphate (pH 3), 210 mMsodium chloride, and 25% acrylonitrile at a flow rate of 1.5 mL/min.Peptide was detected with an ultraviolet (UV) detector set at awavelength of 210 nm. The results show that Dmt-DALDA was virtuallyundetectable in rats given unformulated Dmt-DALDA, whereas as much as 8μg/mL of Dmt-DALDA was detected in rats given Dmt-DALDA formulated incitric acid and lauroyl carnitine. These results clearly demonstratethat formulating Dmt-DALDA in an oral formulation according to thepresent invention increases the C_(max) 19-fold and the AUC 110-foldcompared to the unformulated peptide (see Table II below). Table I(below) sets forth the values upon which the curves in FIG. 1 are based.Table I, moreover, provides the standard deviations for the dataobtained regarding each of the test rats, which standard deviations arealso indicated in FIG. 1.

TABLE I unformulated red white blue min μg/mL μg/mL μg/mL avg sdev sem 00.00 0.00 0.00 0.00 0.00 0.00 5 1.54 0.00 0.00 0.51 0.89 0.51 15 0.000.00 0.00 0.00 0.00 0.00 30 0.00 0.00 0.00 0.00 0.00 0.00 60 0.00 0.000.00 0.00 0.00 0.00 120 0.00 0.00 0.00 0.00 0.00 0.00 formulated minorange green yellow avg sdev sem 0 0.00 0.00 0.00 0.00 0.00 0.00 5 14.152.74 7.19 8.03 5.75 3.32 15 0.80* 4.19 10.75 7.47 4.64 3.28 30 12.023.21 10.37 8.53 4.69 2.71 60 died 2.40 7.10 4.75 3.32 2.35 120 0.00 2.291.14 1.62 1.14 *poor sampling, not included in meanTable II (below) summarizes the pharmacokinetic parameters in rats oforally administered unformulated and formulated Dmt-DALDA as those termsare defined above. Data for the individual rats shown in FIG. 1 aresummarized. C_(max) refers to the maximum concentration of peptidedetected in the rat plasma. The area under the curve (AUC) is a measureof the extent of peptide absorption and is calculated by the trapezoidalrule from a plot of peptide concentration as a function of time. T_(max)indicates when the maximum concentration of the Dmt-DALDA in the bloodserum was obtained.

TABLE II Unformulated Red White Blue Avg (n = 3) Rat DALDA DALDA DALDADALDA Cmax (μg/mL) 1.54 0.00 0.00 0.51 AUC (μg/mL-min) 11.52 0.00 0.003.84 Tmax (min) 5.00 5.00 Formulated Orange Green Yellow Avg (N = 3) RatDALDA DALDA DALDA DALDA Cmax (μg/mL) 14.15 4.19 10.75 9.69 AUC(μg/mL-min) 206.28 253.16 809.91 423.12 Tmax (min) 5.00 15.00 15.0011.67As shown in Table II, the C_(max) and AUC for Dmt-DALDA wassignificantly enhanced when the peptide was administered in a“formulated” solution containing citric acid (pH-lowering agent) andlauroyl carnitine (absorption enhancer).

A second series of tests was carried out, as noted above, using beagledogs. The improved bioavailability of orally administered Dmt-DALDA isdemonstrated in this second series of tests by comparing the curves for(1) non-enteric coated salmon calcitonin (sCT) and (2) non-entericcoated Dmt-DALDA (DALDA) in FIG. 2A with the curves for (3) entericcoated sCT and (4) enteric coated DALDA in FIG. 2B. In the experimentsrepresented in FIGS. 2A and 2B, size 00 HPLC capsules were each filledwith 758 mg of a powdered blend consisting of citric acid (643 mg),lauroyl carnitine (66 mg), talc (33 mg), salmon calcitonin (sCT) (13 mg)and Dmt-DALDA (2.4 mg). Half of the capsules were coated with an entericcoating solution of L30D-55, while the remaining 50% of the capsuleswere not coated. Four fasted dogs were each given 1 uncoated capsule,and 2 weeks later they were each given an enteric coated capsule. Afteradministration of each capsule, samples of blood were taken at 15 minuteintervals from an indwelling catheter for up to 4 hours. The bloodsamples were centrifuged and the resulting plasma supernatants werestored frozen at −20° C. The plasma samples were subsequently analyzedfor sCT by a direct ELISA, and for Dmt-DALDA by HPLC-mass spectrometryperformed as set forth in Wan, H. and Desiderio, D., Quantitation of[DMT ¹ ] DALDA in ovine plasma by on-line liquidchromatography/quadrapole time-of-flight mass spectrometry, RapidCommunications in Mass Spectrometry, 2003; 17, 538-546, the contents ofwhich are incorporated herein by reference.

The results summarized in FIGS. 2A and 2B as plasma peptideconcentration normalized to a 1 mg dose as a function of time relativeto the average T_(max) (i.e., the time at which the maximum amount ofpeptide was detected) indicate that both peptides, i.e., sCT andDmt-DALDA, were detected in dogs given uncoated or enteric coatedcapsules. However, nearly three times as much Dmt-DALDA as sCT wasdetected in dogs given uncoated capsules; whereas, nearly equal amountsof both peptides were detected in dogs given enteric coated capsules.Moreover, nearly four times as much Dmt-DALDA was detected in the plasmaof dogs given enteric coated capsules than those given non-coatedcapsules. Furthermore, nearly eight times as much sCT was detected inthe plasma of dogs given enteric coated capsules than non-coatedcapsules. The maximum concentration of Dmt-DALDA and sCT in dogs givenuncoated capsules was seen 30 minutes after their administration,whereas the maximum concentration of these materials when given incoated capsules was seen 105 minutes after their administration, thusproviding the additional time necessary for the oral formulation to passthrough the stomach while remaining protected from the proteolyticenzymes therein. These results clearly demonstrate that coating thecapsules with an enteric polymer such that the capsule does not releaseits contents until reaching the small intestine significantly enhancespeptide absorption. Table III (below) sets forth the values upon whichthe curves in FIGS. 2A and 2B are based. The results are summarized inthe tables as plasma peptide concentration normalized to a 1 mg dose asa function of time. Table II, moreover, provides the standard deviationsfor the data obtained regarding each of the test dogs, which standarddeviations are also indicated in FIGS. 2A and 2B.

TABLE III Dog 1 Dog 2 Day 3 Day 4 sCT DALDA sCT DALDA sCT DALDA sCTDALDA Min pg/mL pg/mL pg/mL pg/mL pg/mL pg/mL pg/mL pg/mL Non-entericCoated Capsules Containing Citric Acid and Lauroyl Carnitine 0 0 0 0 0 00 0 0 15 0 0 0 0 0 0 0 0 30 2648 4108 3148 6473 0 0 971 5456 45 13435104 2151 5602 278 5788 60 561 4066 897 5726 163 4481 75 273 2407 2294523 101 2934 90 140 2780 182 3568 69 2382 105 121 1938 122 3444 45 3054120 89 1627 69 2614 26 1759 135 51 1158 44 2697 16 1627 150 31 830 392407 12 1544 165 23 913 22 2531 0 1324 180 16 705 15 2075 0 1191 195 11581 0 1328 0 851 210 0 544 0 1867 0 722 225 0 436 0 1535 0 672 240 0 4020 1494 0 556 Enteric Coated Capsules Containing Citric Acid and LauroylCarnitine 0 0 0 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 30 407 0 0 0 0 0 0 0 4522650 29440 0 0 0 0 0 0 60 25136 25224 0 0 0 0 0 0 75 6444 19768 0 0 0 00 0 90 8167 19021 0 0 0 0 0 0 105 4344 12324 0 0 0 0 13111 4577 120 31938108 0 0 0 0 13147 12116 135 2710 10714 0 0 13219 21494 6841 10207 1501706 9349 0 0 10151 19378 4251 6307 165 1283 6743 0 0 4410 12697 24485158 180 1301 5502 0 0 2983 9100 1468 3884 195 459 5008 0 0 1825 48761192 2896 210 347 3021 0 0 1194 4772 867 2664 225 331 2896 0 0 734 4884686 2490 240 179 2527 0 0 626 3651 515 1851

Table IV (below) summarizes the pharmacokinetic parameters in dogs oforally administered sCT and Dmt-DALDA when administered in non-entericcoated versus enteric coated capsules. Peptide was not detected from 1dog in each group due to (a) Dog 3 vomiting the uncoated capsule and (b)delayed gastric emptying in Dog 2 provided with an enteric coatedcapsule. C_(max) and AUC are as defined with regard to Table II above.

TABLE IV Dog Dog 1 Dog 2 Dog 3 Dog 4 Avg (n = 3) dmt- dmt- dmt- dmt-dmt- sCT DALDA sCT DALDA sCT DALDA sCT DALDA sCT DALDA Non-EntericCapsule Cmax (pg/mL) 2648 5104 3148 6473 0 0 971 5788 2256 5788 AUC(pg/mL-min) 79620 410944 103772 707054 0 0 25227 510934 69539 542977Tmax (min) 30 45 30 30 30 45 30 40 Enteric Capsule Cmax (pg/mL) 2513629440 0 0 13219 21494 13147 12116 17167 21017 AUC (pg/mL-min) 11785042375695 0 0 522432 1185373 664016 768361 788317 1443143 Tmax (min) 60 45135 135 120 120 105 100

As shown in Table IV, the C_(max) and AUC values for both sCT andDmt-DALDA were significantly enhanced when the peptides wereadministered in enteric coated capsules versus in non enteric-coatedcapsules. The C_(max) of enteric coated Dmt-DALDA is 4-fold higher thanthat of non enteric coated Dmt-DALDA. Surprisingly, the bioavailabilityof both enteric coated and non-coated Dmt-DALDA is better than that ofsCT. It would be expected that the bioavailability of a molecule such asDmt-DALDA, which is positively charged and hydrophilic, would beextremely poor. The data indicates that when this peptide isadministered in combination with the ingredients of the presentinvention, either with or without an enteric coating, however, thebioavailability is unexpectedly increased to the point where it issuperior to that of sCT, a molecule that has previously been shown to behighly bioavailable when formulated according to the present invention.

The improvement in oral bioavailability achieved with the Dmt-DALDApeptide in accordance with the present invention, i.e.,H-2,6-dimethyltyrosine-D-Arginine-Phenylalanine-Lysine-NH₂, is believedto adequately support an expectation of similarly improved results withthe remaining active agents described herein. With no intention to bebound by theory, applicants submit in explanation therefor that DALDAand other analgesic peptides that are analogs of dermorphin ordeltorphin, as well as other opioid peptides, are highly chargedmolecules. For example, Dmt-DALDA has a 3+ net charge. It would beexpected that these net positive charges would cause the peptide to bindto the negatively charged mucous layer that lines the gastrointestinaltract, thus reducing the bioavailability of the peptide. It is believed,although applicants are not to be bound by such belief, that thenegatively charged citric acid (i.e., the pH-lowering agent), which isin excess in the formulation, would neutralize some or all of thepositive charges on the peptide and thus prevent the interaction betweenthe peptide and the mucous layer. Additionally, applicants believe thatthe positive charge on the acylcarnitine absorption enhancer neutralizethe negative charge on the mucous layer in the immediate vicinity of therelease of the capsule or tablet contents, and therefore would furtherprevent the positively charged peptide from binding with the mucouslayer. The peptide thus remains available to traverse the epitheliallayer in the gastrointestinal tract by paracellular transport throughthe tight junctions between cells, which are relaxed due to the presenceof the acylcarnitine. One of ordinary skill in this art would thereforereasonably expect that the additional active compounds described herein,e.g., the various peptides and their prodrugs, which have a similarsize, charge and hydrophilicity to Dmt-DALDA, would themselves achievean unexpectedly improved degree of bioavailability when administered inthe oral formulation taught and claimed herein.

Although the present invention has been described in relation toparticular embodiments thereof, many other variations and modificationsand other uses will become apparent to those skilled in the art. Thepresent invention therefore is not limited by the specific disclosureherein, but only by the claims.

1-50. (canceled)
 51. A single solid dosage capsule comprising: a peptidecomprising a 2,6-dimethyltyrosine (Dmt) residue or a prodrug thereof; atleast one pharmaceutically acceptable pH-lowering agent comprising acarboxylic acid; and at least one absorption enhancer.
 52. The soliddosage capsule of claim 51 wherein the peptide further comprises anarginine residue, a phenylalanine residue, and a lysine residue.
 53. Thesolid dosage capsule of claim 51 wherein the pH-lowering agent is citricacid.
 54. The solid dosage capsule of claim 51 wherein the absorptionenhancer is an acylcarnitine.
 55. The solid dosage capsule of claim 54wherein the acylcarnitine is lauroyl carnitine.
 56. The solid dosagecapsule of claim 51 further comprising an enteric coating.
 57. The soliddosage capsule of claim 56 wherein the enteric coating is present at aweight which is no more than 20% of the weight of the remainder of thesolid dosage capsule excluding the enteric coating.
 58. The solid dosagecapsule of claim 56 further comprising a water-soluble barrierseparating the pH-lowering agent from the enteric coating.
 59. The soliddosage capsule of claim 51 wherein the pH-lowering agent is present inthe single dosage form in a quantity which, if added to 10 millilitersof 0.1M aqueous sodium bicarbonate solution, would be sufficient tolower the pH of the solution to no higher than 3.5.
 60. The solid dosagecapsule of claim 51 comprising a therapeutically-effective amount-of thepeptide comprising the 2,6-dimethyltyrosine (Dmt) residue or prodrugthereof to achieve analgesia.
 61. A method for relieving pain comprisingadministering to a subject in need thereof a therapeutically-effectiveamount of the solid dosage capsule of claim
 51. 62. A single soliddosage capsule comprising: a deltorphin analog or a prodrug thereofcomprising a dimethylphenylalanine residue; at least onepharmaceutically acceptable pH-lowering agent comprising a carboxylicacid; and at least one absorption enhancer.
 63. The solid dosage capsuleof claim 62 wherein the deltorphin analog isTyrosine-D-alanine-Xaa-Glutamic Acid-Valine-Valine-Glycine-NH₂, whereinXaa is L or D-dimethylphenylalanine.
 64. The solid dosage capsule ofclaim 62 wherein the pH-lowering agent is citric acid.
 65. The soliddosage capsule of claim 62 wherein the absorption enhancer is lauroylcarnitine.
 66. The solid dosage capsule of claim 62 further comprisingan enteric coating.
 67. The solid dosage capsule of claim 66 wherein theenteric coating is present at a weight which is no more than 20% of theweight of the remainder of the solid dosage capsule excluding theenteric coating.
 68. The solid dosage capsule of claim 62 wherein thepH-lowering agent is present in the single dosage form in a quantitywhich, if added to 10 milliliters of 0.1M aqueous sodium bicarbonatesolution, would be sufficient to lower the pH of the solution to nohigher than 3.5.
 69. The solid dosage capsule of claim 62 comprising atherapeutically-effective amount-of the deltorphin analog or prodrugthereof comprising the dimethylphenylalanine residue to achieveanalgesia.
 70. A method for relieving pain comprising administering to asubject in need thereof a therapeutically-effective amount of the soliddosage capsule of claim 62.